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This is VAERS ID 286188

Case Details

VAERS ID: 286188 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: New Jersey  
Vaccinated:2007-03-24
Onset:2007-07-22
   Days after vaccination:120
Submitted: 2007-07-27
   Days after onset:5
Entered: 2007-07-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Enema administration, Intussusception
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: barium enema X-ray - IT corrected 8/27/07-records received-Xray KUB: stool filled colon. US abdomen: RUQ intussusception. Fluoroscopically guided air enema reduced intussusception. PMH: pylonmyotomy at 5 weeks for pyloric stenosis. Labs: neutrophils 71.0, lymphs 18.0, glucose 112, total bilirubin 0.9.
CDC Split Type: WAES0707USA04056

Write-up: Information has been received from a registered nurse concerning a 10-month-old male who on 13-NOV-2006, 12-JAN-2007, and 24-MAR-2007 was vaccinated with the first, second, and third doses of Rotateq. On 22-JUL-2007 the patient experienced intussusception and was hospitalized. The intussusception was corrected with a barium enema and the child was released from the hospital. The patient recovered. No other information was available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested. 8/27/07-records received for DOS-7/22/07-DX: Intussusception. Reduced with Barium enema. C/O abdominal pain since toady 7/22/07-Cranky, crying, waking up. No fever. No vomiting. No diarrhea. No rash.


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